05/23/2017

Who Owns the WHO? The Politics of Naming Disease

As a philosopher of disability, I have long been wary (as have most disability theorists and activists) of how the World Health Organization (WHO) classifies disability, recognizing the fundamentally political character of the classifications, the distinctions on which they rely, and the implications of these discursive mechanisms for the economic and social policies of governments worldwide and for the social, cultural, and economic concrete realities of disabled people's lives.

I first wrote about the political implications of WHO classificatory schemes in "Biopower, Styles of Reasoning, and What's Still Missing From the Stem Cell Debates," published in Hypatia in 2010. In my forthcoming book, I tie the naming of disability and the political character of the apparatus of disability more generally to the rise and expansion of neoliberalism and, in particular, to the rise and expansion of bioethical discourse.

Thus, I was quite interested to read an article entitled "Who Names Diseases?" which draws attention to the political nature of naming disease and the political interests that have come to drive WHO, a "non-governmental" multilateral that has long been widely regarded as "apolitical," "politically neutral," and largely "value neutral." I was especially interested in the article's discussion of evolutionary ecologist Rob Wallace's book Big Farms Make Big Flu. Here is an excerpt from the article:

Wallace acknowledges that the origins of disease are often complex, and makes a distinction between the absolute and relational geography of a disease. The first cases of Ebola were identified in the River Ebola region of what is now the Democratic Republic of Congo. It was named for its absolute geography, in other words, which he agrees was unhelpful. But its relational geography is informative. Ebola emerged where it did in part because of increased contact between humans and the virus’ natural reservoir, bats – the result of deforestation carried out to facilitate logging and mining operations. The situation might have been exacerbated by the dismantling of public health services in the region following years of structural adjustment. Follow the money generated by those operations, trace the structural adjustment loans back to their lenders, and you end up in the world’s financial capitals: London, New York and Hong Kong. ‘Those are the true Ebola hotspots,’ he says.

In masking the relational geography of disease, Wallace argues, the WHO is deflecting discussion of the relationship between the reorganisation of primary industries – particularly food production – and the emergence of new zoonoses. That discussion is an essential precursor to another, about the need to reform our food-production model to prevent future pandemics. ‘It’s a slow industrial accident that we are witnessing,’ he says, ‘and that we are refusing to do anything about.’ He worries that the one organisation that could facilitate that discussion is no longer sufficiently independent to do so.

The WHO’s income is derived from a combination of members’ dues, which it sets, and voluntary contributions from member states who want to give more, as well as non-governmental organisations, drug companies and agribusinesses. Over the years, these voluntary contributions have crept up to more than 80 per cent of the budget – most of it earmarked for specific projects or diseases, ‘making it next to impossible for the WHO to have much of a say in its own agenda’, as a recent editorial in Nature put it. Knowing that effective disease surveillance depends on the cooperation of its member states, the WHO has always practised diplomacy. But dependent as it increasingly is on the goodwill of its funders, diplomacy has become critical to its survival.